Individual provider Active NPI

Hassan Jalil, D.D.S.

  • Dentist
  • Villa Park, IL
National Provider Identifier
1629356704
Registry record updated Jul 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.028763 Issued in IL
Practice address
626 N Addison Rd
Villa Park, IL 60181-1419
Phone
(630) 359-0105
NPI assigned
Jul 24, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019.028763 IL Primary

Addresses

Primary practice location

626 N Addison Rd
Villa Park, IL 60181-1419

Mailing address

626 N Addison Rd
Villa Park, IL 60181-1419
Phone (630) 359-0105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171107002902 IL Order and Referring Only - DentistPractitioner - Dentist 0648536631

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.028763ILMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311465600000",
    "number": "1629356704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 N ADDISON RD",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601811419",
            "telephone_number": "630-359-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 N ADDISON RD",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601811419",
            "telephone_number": "630-359-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALIL",
        "first_name": "HASSAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-24",
        "last_updated": "2011-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.028763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Park, IL

Sources for this page

Verify at the official NPI Registry.